Provider Demographics
NPI:1033525142
Name:LUIS MIGUEL GONZALEZ DDS PLLC
Entity Type:Organization
Organization Name:LUIS MIGUEL GONZALEZ DDS PLLC
Other - Org Name:32 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-876-5236
Mailing Address - Street 1:3141 CAPITAL BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3378
Mailing Address - Country:US
Mailing Address - Phone:919-876-5236
Mailing Address - Fax:
Practice Address - Street 1:3141 CAPITAL BLVD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3378
Practice Address - Country:US
Practice Address - Phone:919-876-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty